Little League Shoulder Symptoms & Causes

Contact the Hand and Orthopedic Upper Extremity Program

Little League shoulder is usually caused by overuse or poor throwing technique, and most often occurs in pitchers, catchers and other athletes who do overhand activities, including volleyball and tennis players. There are three bones that make up a shoulder—the collar bone, the upper arm bone and the shoulder blade. The shoulder blade and the upper arm bone are connected by a joint, and very close to that joint is a growth plate.

Growth plates are small, soft parts of a bone that are located near both ends of long bones. In the case of Little League shoulder, doctors are most concerned with the growth plate that sits high on the upper arm bone, near the shoulder. If that growth plate is inflamed or irritated, it usually means the child has Little League shoulder.

Signs and symptoms

If your child has the following symptoms, he should see a doctor:

• Shoulder pain while throwing
• Soreness that lasts a few days
• Slower and less controlled throws than normal
• Swelling or tenderness near the shoulder

In general, your child should stop throwing for three months, and attend physical therapy to stretch and strengthen the shoulder muscles. Children usually return to sports in several months, with approval from their doctor and physical therapist. Read more about treatment and care.

It’s important to note that Little League shoulder can be prevented. Talking to a child’s pitching coach about the way they throw, where they release the ball, and how they position their arm and wrist can help improve technique and protect from pain.

Throwing guidelines

USA Baseball has put together guidelines for how much throwing an athlete should do on a regular basis:

9- to 10-year-old pitchers:

11- to 12-year-old pitchers:

13- to 14-year-old pitchers:

• 50 pitches per game
• 75 pitches per week
• 1,000 pitches per season
• 2,000 pitches per year

• 75 pitches per game
• 100 pitches per week
• 1,000 pitches per season
• 3,000 pitches per year

• 75 pitches per game
• 125 pitches per week
• 1,000 pitches per season
• 3,000 pitches per year

More guidelines have been established in order to ensure proper rest time between pitching as well:

For pitchers age 7 to 16:

For pitchers age 17 to 18:

Pitches in a day Rest time61 or more 4 days
41-60 3 days
21-40 2 days
1-20 1 day

Pitches in a day Rest time
76 or more 4 days
51-75 3 days
26-50 2 days
1-25 1 day

These pitch counts should also be applied to athletes who belong to multiple teams at a time, or play in multiple leagues per year. It’s recommended that athletes take three months each year off from their sport, and vary sports in order to diversify muscle groups and give their throwing muscles a break.

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